Major Legislative Milestones in US Immigration History - New York ...

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Key Design ElementsIn thinking about how to structure access to health care at the local level fortemporary workers and other individuals who participate in an immigrationreform program, the following considerations are important:STAKEHOLDER INVESTMENTEmployer and employee assessments or contributions are assumed to be the primarysource of funding for access to health care when discussing policy options. Immigrationreform that is designed to benefit employers and workers should come with theexpectation that each will contribute to ensuring adequate access to health care.Employers that provide health insurance benefits to workers who benefit from immigrationreform could be granted an offset or credit against the employer’s assessedcost of participating in the immigration program (payment of fees, for example).FAIRNESS IN TAXATIONWorkers who reside in the United States and pay federal income taxes shouldbe able to obtain federal means-tested public benefits on the same basis as anyother American if they fall on hard times. This basic fairness is especially relevantwhen faced with urgently needed, expensive medical care. 1ACCESS TO EMERGENCY CAREEmergency medical transportation and emergency health care are generallyextended to all persons in the United States experiencing an emergency medicalcondition, upholding our long-standing respect for basic human decency;immigration reform should retain this commitment to all US residents. 2STOP-LOSS PROTECTION FOR CATASTROPHIC CAREMedical care is extremely expensive for the vast majority of Americans and isdistinct in nature from other types of expenses and debts because medical careis often incurred involuntarily. US citizens gain access to Medicaid if they havelimited income and exhaust their disposable resources. 3 Migrants admitted1 For a description of the restrictions currently imposed on legal immigrants’ access to Medicaid and the StateChildren’s Health Insurance Program (SCHIP), see the US Department of Health and Human Services,Centers for Medicare and Medicaid Services (CMS) Web site:http://www.cms.hhs.gov/MedicaidEligibility/05_Immigrants.asp#TopOfPage.2 42 U.S.C. § 1395dd. US Department of Health and Human Services, Centers for Medicare and MedicaidServices (CMS) Emergency Medical Treatment and Labor Act (EMTALA) Web site:http://www.cms.hhs.gov/EMTALA.3 US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) Website: http://www.cms.hhs.gov/home/medicaid.asp. See also, “The Medicaid Program At a Glance”(Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation,2005), http://www.kff.org/medicaid/upload/The-Medicaid-Program-at-a-Glance-Fact-Sheet.pdf.168S ecuring the Future: US Immigrant Integration Policy
under immigration reform will need some form of stop-loss protection againstcatastrophic medical costs; options include Medicaid, 4 Medicare, or restrictedscope Medical Assistance for an emergency medical condition (“emergencyMedicaid”). 5 This protection will also ensure that safety net health providersare reimbursed, at least in part, for the costs of treating low-income patients.RESIDENCYParticipants in immigration reform should be treated at least as favorably as H-1 visa holders for the purposes of participating in programs and services thatcurrently impose a state or local residency requirement. Examples of programsthat require proof of residency but not legal status include public health services,federally qualified health centers, hospital reimbursement for the treatmentof an emergency medical condition through “emergency Medicaid,” and, instates such as New York, free or subsidized insurance for children, pregnantwomen, and individuals living with HIV and AIDS. 6PUBLIC NOTICEThe nation’s experience with the recent drug reimbursement or MedicarePart D program clearly demonstrates how important it will be for the governmentto provide clear instructions about health programs to participants inimmigration reform. Clear communications will be vital to addressing concernsand misconceptions that lead many foreign-born individuals to avoidusing health programs. 7Policy OptionsAccess to health care is important to workers, employers, and communitiesalike. Public health is safeguarded only when all members of a community arewilling to come forward for screening and treatment in the event of an epidemicor biological or chemical exposure. Employers experience workers’ illness,4 The federal Medicaid program’s medically needy (MN) option allows states to extend Medicaid eligibility topersons whose income and/or resources are above the eligibility level set by their state. Persons may qualifyimmediately or may “spend down” by incurring medical expenses that reduce their income to or below theirstate’s MN income level. Thirty-five states have adopted the medically needy option, and the remainingstates have Medicaid for people who are “near poor.” More information can be found at:http://www.cms.hhs.gov/MedicaidGenInfo/03_TechnicalSummary.asp#TopOfPage.5 J. Perkins, “Medicaid Coverage of Emergency Medical Conditions,” Clearinghouse Review Journal of PovertyLaw and Policy 384 (Sept/Oct 2004).6 New York State, Department of Health — Medical Assistance Program: GIS 04 MA/003 Attachment 1,2004.7 T. Bauer, J. Bergman, C. Hill, J. Fuld, and L. Weiss, “Access to Health Insurance and Health Carefor Children in Immigrant Families” (New York: The New York Academy of Medicine, publicationforthcoming).A ppendix II 169
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Page 7 and 8: younger than 19. 9 The program allo
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